REPATRIATION MEDICAL AUTHORITY

INSTRUMENT NO. 54 of 2009

VETERANS’ ENTITLEMENTS ACT 1986

MILITARY REHABILITATION AND COMPENSATION ACT 2004

EXPLANATORY NOTES FOR TABLING

1. The Repatriation Medical Authority (the Authority), under subsection 196B(8) of the Veterans' Entitlements Act 1986 (the VEA) revokes Instrument No. 23 of 1995 determined under subsection 196B(2) of the VEA concerning trigeminal neuralgia and death from trigeminal neuralgia.

2.             The Authority is of the view that there is sound medical-scientific evidence that indicates that trigeminal neuralgia and death from trigeminal neuralgia can be related to particular kinds of service.  The Authority has therefore determined pursuant to subsection 196B(2) of the VEA a Statement of Principles, Instrument No. 54 of 2009 concerning trigeminal neuralgia.  This Instrument will in effect replace the revoked Statement of Principles.

3.             The provisions of the Military Rehabilitation and Compensation Act 2004 (the MRCA) relating to claims for compensation commenced on 1 July 2004.  Claims under section 319 of the MRCA for acceptance of liability for a service injury sustained, a service disease contracted or service death on or after 1 July 2004 are determined by the Military Rehabilitation and Compensation Commission by reference to Statements of Principles issued by the Authority pursuant to the VEA.

4.             The Statement of Principles sets out the factors that must as a minimum exist, and which of those factors must be related to the following kinds of service rendered by a person:

 operational service under the VEA;

 peacekeeping service under the VEA;

 hazardous service under the VEA;

 warlike service under the MRCA;

 non-warlike service under the MRCA,

before it can be said that a reasonable hypothesis has been raised connecting trigeminal neuralgia or death from trigeminal neuralgia, with the circumstances of that service.

5.             This new instrument results from an investigation notified by the Authority in the Government Notices Gazette of 28 June 2006 concerning trigeminal neuralgia in accordance with section 196G of the VEA.  The investigation involved an examination of the sound medical-scientific evidence now available to the Authority, including the sound medical-scientific evidence it has previously considered.

6.             The contents of the new Instrument are in similar terms as the revoked Instrument.  Comparing the new and the revoked Instruments, the differences include:

• adopting the latest revised Instrument format, which commenced in 2005;
• deleting the ICD code from the Instrument header;
• revising the definition of 'trigeminal neuralgia' in clause 3;
• revising factor 6(a) concerning 'multiple sclerosis';
• new factor 6(b) concerning 'mass lesion' which incorporates the previous factors concerning 'tumours' and 'vascular lesions';
• new factors 6(c) and 6(i) concerning 'cerebrovascular accident';
• revising factor 6(d) concerning 'inflammatory connective tissue disease';
• new factor 6(e) concerning 'benign osseous lesion' which incorporates the previous factor concerning 'Paget's disease of the skull';
• new factors 6(f) and 6(l) concerning 'localised infection';
• delete factors concerning 'cerebral malaria' and 'leprosy';
• new factor 6(g) concerning 'multiple sclerosis';
• new factor 6(h) concerning 'mass lesion';
• new factor 6(j) concerning 'inflammatory connective tissue disease';
• new factor 6(k) concerning 'benign osseous lesion';
• new definition of 'a benign osseous lesion', 'a mass lesion', 'a localised infection from the specified list', 'an inflammatory connective tissue disease from the specified list', 'death from trigeminal neuralgia', 'relevant service' and 'terminal event' in clause 9;
• delete definitions of 'cerebral malarial', 'connective tissue diseases', 'ICD code', 'leprosy', 'multiple sclerosis', 'Paget's disease', and 'tumour'; and
• specifying a date of effect for the Instrument in clause 11.

7.             Further changes to the format of the Instrument reflect the commencement of the MRCA and clarify that pursuant to subsection 196B(3A) of the VEA, the Statement of Principles has been determined for the purposes of both the VEA and the MRCA.

8.             Prior to determining this instrument, the Authority advertised its intention to undertake an investigation in relation to trigeminal neuralgia in the Government Notices Gazette of 28 June 2006, and circulated a copy of the notice of intention to investigate to a wide range of organisations representing veterans, service personnel and their dependants.  The Authority invited submissions from the Repatriation Commission, organisations and persons referred to in section 196E of the VEA, and any person having expertise in the field.  No submissions were received for consideration by the Authority during the investigation.

9.             On 22 April 2009, the Authority wrote to organisations representing veterans, service personnel and their dependants regarding the proposed Instrument and the medical-scientific material considered by the Authority. This letter emphasised the deletion of factors relating to cerebral malaria and leprosy. The Authority provided an opportunity to the organisations to make representations in relation to the proposed instrument prior to its determination. No submissions were received for consideration by the Authority.

10.         The determining of this new instrument finalises the investigation in relation to trigeminal neuralgia as advertised in the Government Notices Gazette of 28 June 2006.

11.         A list of references relating to the above condition is available to any person or organisation referred to in subsection 196E(1)(a) to (c) of the VEA.  Any such request must be made in writing to the Repatriation Medical Authority at the following address:

The Registrar

Repatriation Medical Authority Secretariat

GPO Box 1014

BRISBANE    QLD    4001